Kathryn Berlacher

Using an ACTIVE teaching format versus a standard lecture format for increasing resident interaction and knowledge achievement during noon conference: a prospective, controlled study

BackgroundThe traditional lecture is used by many residency programs to fulfill the mandate for regular didactic sessions, despite limited evidence to demonstrate its effectiveness. Active teaching strategies have shown promise in improving medical knowledge but have been challenging to implement within the constraints of residency training. We developed and evaluated an innovative structured format for interactive teaching within the residency noon conference.MethodsWe developed an ACTIVE teaching format structured around the following steps: assemble (A) into groups, convey (C) learning objectives, teach (T) background information, inquire (I) through cases and questions, verify (V) understanding, and explain (E) answer choices and educate on the learning points. We conducted a prospective, controlled study of the ACTIVE teaching format versus the standard lecture format, comparing resident satisfaction, immediate knowledge achievement and long-term knowledge retention. We qualitatively assessed participating faculty members’ perspectives on the faculty development efforts and the feasibility of teaching using the ACTIVE format.ResultsSixty-nine internal medicine residents participated in the study. Overall, there was an improvement in perceived engagement using the ACTIVE teaching format (4.78 vs. 3.80, P < 0.01), with no increase in stress or decrement in break time. There was an improvement in initial knowledge achievement with the ACTIVE teaching format (overall absolute score increase of 11%, P = 0.04) and a trend toward improvement in long-term knowledge retention. Faculty members felt adequately prepared to use the ACTIVE teaching format, and enjoyed teaching with the ACTIVE teaching format more than the standard lecture.ConclusionsA structured ACTIVE teaching format improved resident engagement and initial knowledge, and required minimal resources. The ACTIVE teaching format offers an exciting alternative to the standard lecture for resident noon conference and is easy to implement.

COCATS 4 Task Force 5: Training in Echocardiography: Endorsed by the American Society of Echocardiography

The writing committee was selected to represent the American College of Cardiology (ACC) and American Society of Echocardiography (ASE) and included a cardiovascular training program director, an echocardiography training program director, early-career echocardiography experts, highly experienced specialists practicing in both the academic and communitybased practice settings, and physicians experienced in defining and applying training standards according to the 6 general competency domains promulgated by the Accreditation Council for Graduate Medical Education (ACGME) and American Board of Medical Specialties (ABMS) and endorsed by the American Board of Internal Medicine (ABIM). The ACC determined that relationships with industry or other entities were not relevant to the creation of this general cardiovascular training statement. Employment and affiliation details for authors and peer reviewers are provided in Appendixes 1 and 2, respectively, alongwith disclosure reporting categories. Comprehensive disclosure information for all authors, including relationships with industry and other entities, is available as an online supplement to this document.

Understanding the challenges to facilitating active learning in the resident conferences: a qualitative study of internal medicine faculty and resident perspectives

Background In the Next Accreditation System, the Accreditation Council for Graduate Medical Education outlines milestones for medical knowledge and requires regular didactic sessions in residency training. There are many challenges to facilitating active learning in resident conferences, and we need to better understand resident learning preferences and faculty perspectives on facilitating active learning. The goal of this study was to identify challenges to facilitating active learning in resident conferences, both through identifying specific implementation barriers and identifying differences in perspective between faculty and residents on effective teaching and learning strategies. Methods The investigators invited core residency faculty to participate in focus groups. The investigators used a semistructured guide to facilitate discussion about learning preferences and teaching perspectives in the conference setting and used an ‘editing approach’ within a grounded theory framework to qualitative analysis to code the transcripts and analyze the results. Data were compared to previously collected data from seven resident focus groups. Results Three focus groups with 20 core faculty were conducted. We identified three domains pertaining to facilitating active learning in resident conferences: barriers to facilitating active learning formats, similarities and differences in faculty and resident learning preferences, and divergence between faculty and resident opinions about effective teaching strategies. Faculty identified several setting, faculty, and resident barriers to facilitating active learning in resident conferences. When compared to residents, faculty expressed similar learning preferences; the main differences were in motivations for conference attendance and type of content. Resident preferences and faculty perspectives differed on the amount of information appropriate for lecture and the role of active participation in resident conferences. Conclusion This study highlights several challenges to facilitating active learning in resident conferences and provides insights for residency faculty who seek to transform the conference learning environment within their residency program.

Cardiovascular magnetic resonance stress perfusion imaging predicts 1 year outcomes following equivocal stress testing

Summary We tested the hypothesis that cardiovascular magnetic resonance (CMR) stress perfusion can predict 1 year outcomes in individuals with equivocal or uncertain prior stress testing. Background Individuals with equivocal nuclear stress test results are at higher risk for cardiac events compared to those with normal studies. CMR stress perfusion imaging identifies individuals with coronary artery disease with high sensitivity and specificity, with excellent spatial resolution, and without ionizing radiation. The utility of CMR stress testing is uncertain in individuals with prior equivocal stress results. Methods We selected all participants in a CMR registry who were clinically referred for pharmacologic CMR perfusion testing due to recent nuclear stress perfusion study (6 months if outpatient, same admission if inpatient) from 2009-2010 with equivocal or uncertain results. Studies were defined as equivocal if the results were qualified by the mention of significant artifact or other technical difficulty. Studies were defined as uncertain if the referring physician documented suspicion of false positive or false negative results in the medi cal record. The presence of ischemia reported by each modality, as well as any description of uncertainty, was determined by a clinical nurse reviewer and 2 cardiologists (all blinded to the downstream clinical course of each subject). Any disagreement in assessment was arbitrated by majority vote. The clinical course of each subject was followed through chart review. Adverse outcome was defined as hospitalization for suspected or definite myocardial infarction.